OBJECTIVE: To investigate whether genital ulcer
diseases are cofactors which enhance the transmission of
HIV-2 in West Africa.

DESIGN: A cross-sectional study of 435 men
presenting with a sexually transmitted disease (STD).

SETTING: The outpatient clinic of the Medical
Research Council Laboratories, a primary care facility in
Fajara, a suburb of Banjul, the capital city of The Gambia
(West Africa).

PATIENTS, PARTICIPANTS: Six hundred and twenty-four
men presenting with a genital complaint, of whom 443 had an
STD. Eight of the men with an STD were excluded from further
analysis because they were HIV-1-infected (five patients) or
had indeterminate Western blot patterns (three patients). The
remaining 21 HIV-2-infected and 414 seronegative men
constituted our study-group.

MAIN OUTCOME MEASURES: Participants were questioned
about previous STD and behavioural and demographic
characteristics. A physical examination was performed and
serum collected for measurement of antibodies against
Haemophilus ducreyi and Treponema pallidum.

RESULTS: HIV-2-infected men were more likely than
HIV-seronegative participants to have previously had a
genital ulcer [odds ratio (OR), 3.00; 95% confidence interval
(Cl), 1.18-7.60] and to have antibodies against T. pallidum
(OR, 5.95; 95% Cl, 2.10-16.91), or H. ducreyi (OR, 4.59; 95%
Cl, 1.71-12.33). Circumcised patients with residual foreskin
were more likely to be HIV-2 infected than patients with
complete circumcision. HIV-2-seropositive patients were six
times more likely to have generalized lymphadenopathy than
their seronegative counterparts.

CONCLUSIONS:Our data suggest
that genital ulcerative diseases, such as syphilis and
chancroid, are probably cofactors that increase the
transmission of HIV-2 in West Africa, and that HIV-2
infection frequently results in generalized
lymphadenopathy.